Sex differences in cardiovascular-related hospital readmissions, adverse events and interventions within 1 year after ST-elevation myocardial infarction

Abstract Introduction Reducing cardiovascular (CV)-related hospital readmissions as well as adverse events following ST- elevation myocardial infarction (STEMI) is a critical goal to improve outcomes as well as quality of life and reduce healthcare costs. We aimed to study the rates of CV-related readmissions, adverse events and interventions after STEMI in women and men. Methods We included STEMI patients from the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry, who underwent percutaneous coronary intervention (PCI) between 2013 and 2022 and participated in a telephone-based follow-up (FU) interview 1-year after hospital admission. Patients were asked if they had hospital readmissions (if yes: planned/emergency/both) during FU for any CV reason, if they suffered a reinfarction or stroke and if they had any or several of the following interventions: PCI, coronary artery bypass graft, pacemaker and/or defibrillator implantation. These self-reported data were analysed using descriptive statistics and logistic regression models were used to study the relationship between patient characteristics and hospital readmissions. Results Of 4388 PCI-treated STEMI patients contacted for FU, 275 (6.3%) were unreachable, 118 (2.7%) died, and 223 (5.1%) had no data on readmissions; therefore 3772 patients (78.4% men, 21.6% women) were analysed. Women were older (mean (SD) age at event: 68.4 (12.0) vs. 62.5 (11.5) years) while the Charlson Comorbidity Index (CCI) was similar (CCI>1: 14.0% vs. 12.1%, n.s.). The mean rate of patients readmitted for CV reasons was 22.1%; 20.4% for women and 22.6% for men (p=0.198). Overall, 8.8% had at least one emergency and 13.9% at least one planned readmission. The occurrence of a planned readmission was significantly lower in women (11.1% vs. 14.7%, p=0.008). Patients with a readmission had during the index hospitalisation higher rates of in-hospital complications (18% vs. 14%), heart failure (NYHA III+IV) (2.2% vs. 0.8%), diabetes (18% vs. 14%) and peripheral arterial disease (3.9% vs. 2.5%). A multivariable adjusted model that included these factors together with age and sex identified heart failure (OR: 2.5, CI 1.34-4.66, p=0.004) and in-hospital complications (OR:1.4, CI 1.12-1.70, p=0.003) as independent predictors of hospital readmission. The rates of the analysed adverse events and interventions were similar between sexes except that women had less often a PCI during the FU period (13.2% vs. 16.6%, p=0.026). Conclusion Over the last 10 years, on average 1 in 5 patients had at least one CV-related readmission within 1 year after PCI-treated STEMI, while no overall sex-difference was found. Heart failure and in-hospital complications were independent predictors of readmission. Women had less often planned hospital readmissions and additional PCIs.